A l A m e e n J M e d S c i 2 0 2 0 ; 1 3 ( 3 ) : 1 3 7 - 1 4 0 ● US National Library of Medicine enlisted journal ● I S S N 0 9 7 4 - 1 1 4 3

EDITORIAL CODEN: AAJMBG

Surgeon and COVID times

Jignesh Gandhi*
Department of General Surgery, Seth GS Medical College & KEM Hospital, Acharya Donde Marg,
Parel, Mumbai-400012, Maharashtra, India

Received: 29th May 2020; Accepted: 18th June 2020; Published: 01st July 2020

Introduction
Surgeons have taken up professional and
“Nothing in life is to be feared, it is only to be
ethical responsibility to render the best care as
understood. Now is the time to understand more,
a part of the treatment for COVID patients. In
so that we may fear less” -Madam Curie
order to help the public health system, they
have compromised their own personal safety
Who would have wondered that these words
and have sacrificed their personal and family
would prove to be more applicable at a time when
life for the same.
the world is overcome with gloom and the fear of
the corona virus disease now known as COVID-
It looks like there are lots of stumbling blocks
19. This is the worst crisis faced by mankind
and challenges ahead for the surgical
since the Spanish Flu of 1918 [1]. Surgeons have
fraternity as we sail past this tsunami of the
shifted base from patient centric ethics to public
current pandemic. We need to look at various
health centric ethics [1]. There is an inevitable
problems and offer apt solution to mitigate
stress to surgeons worldwide as they are forced to
these within our own capacity at various
stop elective surgical work and shift their priority
levels of institutions.
towards other aspects of patient care. This
changing scenario of ethics is purely due to the
Multidisciplinary Training
scarcity of health care resources compared to the
escalating number of COVID positive loads of There is a need to cohort and centralise the
COVID positive patients seeking medical care. care of COVID -19 patients specially those
requiring intensive care system and deploy
Surgeons are used to rigorous operating room specialist core groups from various tertiary
schedules, working at odd hours, managing care hospitals to manage those group of
complex patients, devoting long hours in the patients. There is constant pressure of the
clinic and have never been accustomed to waiting increasing workload on our physician
at home & doing odd non operative work. This colleagues and as a surgeon, we will have to
paradigm shift may not be surgeon friendly but it step out of our comfort zone to get trained
will be helpful to preserve the scarce medical along with these specialists to shoulder the
human resource considering the magnitude of this combined responsibility in managing these
pandemic and the unforeseeable shortage of critically ill patients [2]. Surgeons have also
doctors in future. Surgeons managing COVID been instrumental in performing
positive surgical patients have shifted to a greater administrative and front line roles as and
level of paternalism compared to the shared when required by the institutions.
decision making with patients, which was a
common ritual before COVID times. We are now Building up Team Morale
moving towards the surgeon’s veto decision
It is a commendable gesture to roster a senior
making and not respecting our patient’s wishes,
surgeon for COVID duties and breaking the
due to the inherent unknown nature of this illness.

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Al Ameen J Med Sci; Volume 13, No.3, 2020 Editorial

hierarchy system, but there would be a potential education has been revived by means of web
risk to expose them to the disease earlier on in based meetings reaching out to the surgical
this pandemic and later finding difficulty to fraternity with evidence based guidelines and
obtain a suitable replacement. However, the establishing standard protocols to manage
contribution of senior leadership in administrative COVID and non COVID surgical patients.
roles and decision making is equally vital, Internet based knowledge has led to a new
especially when the burden of decisions affects problem of multiple sources of information
the lives of countless fellow colleagues, from anecdotal case reports to institutional
healthcare workers, and their family members. trials to media based information leading to a
Senior surgeons can boost the morale of the mental fatigue over a period of time to absorb
junior fraternity by proper manpower planning, to the real substance of this information [3-4].
ensure adequate work rest cycle so that the junior
colleagues get adequate personal and family time. Surgeons also have to find the silver lining to
start elective surgical work and one of the
Together yet isolated strong reason being the breaking of their
personal financial ecosystem cycle and the
In the larger interest of the department and
mounting pressure at the end of the
institution, its time that the faculty come together
moratorium period. It is sad to see any
to have an open discussion, suggest different
surgical fraternity succumbing to this disease
view points and work together in this world of
and it would take a retrospective analysis in
social distancing to ensure smooth working and
the long term to evaluate the non COVID
implementation of institutional and government
reasons for the premature deaths of these
protocols. It’s time that in this context we flatten
surgical heroes across the globe. Elective
the hierarchy because its been proved that some
surgical work needs to start as the pressure
of the brilliant suggestions come from the junior
which will build up on the institutions after
most members in the team. Internal conflicts
flattening the curve would be enormous and
would only led to chaotic situations and may
it’s time we strike a balance between rushing
worsen the already disastrous existing scenario of
to start elective works versus a gradual
managing this dreadful disease.
transition, working as a team and dividing
responsibilities.
Improper decisions may impact the clinical care
and health of our front line workers. We will have
As we rise to the challenges ahead of us, the
to develop unconditional trust towards policy
traditional role of the surgeon remains crucial,
makers and governing council members who are
and delivery of quality emergency and urgent
safe guarding the larger interest in the healthcare
surgical care must continue. The road ahead
system. It is also important that each one of us
may be long and cobblestoned, but with
should render support to the established protocol
resilience, we will eventually emerge from
so as to ensure a safe working environment, like
this crisis triumphant and will redefine our
doing an HRCT chest in defined group of patients
roles as surgeons for many generations to
preoperatively to help our anaesthesiology
come.
colleagues better plan intubation procedures and
post-operative ventilator support.
Learning the new armamentarium
Every cloud has a silver lining Personal Protective equipment (PPE), rational
use of the right mask or a respirator, donning
This pandemic era has led to an avalanche of
and doffing techniques are the new variables
drastic changes in our surgical practise. Change is
in the learning curve for a surgeon. Respirator
a consequence of innovation and it is during this
and mask represent a different identity and the
extraordinary times that innovative solutions to
surgeon needs to understand the transit from
manage healthcare and medical education are
rationale use of the right respiratory protective
born. Leaner manpower in the surgical
equipment (RPE) since this being a
department has shown that we can efficiently
predominantly aerosol transmitted disease the
manage our non COVID patients with
respiratory protection seems to be of
telemedicine and teleconferencing. Surgical
paramount significance [5].

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Al Ameen J Med Sci; Volume 13, No.3, 2020 Editorial

Surgeon should pay gratitude to the great select instances demeaned the surgical
invention of the surgical mask by Jan Miculicz fraternity purely based on sharing incomplete
and Carl Flugge almost a century back around the information, which has not hit a right chord
time of Spanish flu and that is now the most with doctors. I think it is time that we embrace
important saviour for the human mankind. it as constructive criticism and move ahead
Adaptation of the mask to respirator is now the with optimism.
need of the hour and understanding certain basics
like use of proper fitting N95 mask, not to use Resources
mask with an exhale valve, use of breathing
Never in the history of mankind has there
apparatus system for surgeon during surgical
been so much focus on the preservation of
procedures has become inevitable [2].
human resources, critical care medicines,
invasive ventilation machines, food supply
PPE is now the accepted shield for the surgeon
chains, non-essential commodities and many
and it looks like in spite of all the problems
more. Surgeons have played an important role
associated with donning and doffing of PPE,
by adapting to minimal invasive surgical
impaired ergonomically performance of the
techniques with safety precautions thereby
surgeon wearing the PPE, its long term
reducing the hospital resources, shorter
association with surgeon would continue and we
hospital stay, minimum morbidity and thereby
will need to adapt and get over the learning curve
significantly improving the health economics.
of this new protective shield [6]. There have been
The medical industry has collaborated with
various discussions on intellectual forums about
government bodies to ensure a continuous
the rationale adaptation to the usage of PPE, but
supply of the critical care medicines ignoring
not to forget the amount of potential harmful new
their profit incentives for the COVID patients
chemicals generated through disposing them and
nation-wide. Generous donations of invasive
the additional human resource required to dispose
ventilation equipment by the leaders of the
them adapting a standard protocol method. While
developed countries have proved how the
personal protection remains of paramount
human race joins hand together in times of
importance, patient care cannot be compromised.
natural calamity and proving that world is one
A cool head in the operating room and a correct
family.
temperament can strike a balance between the
minimal resources available and achieving quality
Psychological Support
surgical care [7].
Not long ago was there a need to have
Support system for Healthcare workers counselling for our patients coming to the
hospital. However with fear mongering due to
Initially there was stigmatization of Health care
the COVID disease this has now become
workers (HCWs) by the public in the initial
customary. HCWs have suffered a huge
stages of the outbreak, but now there has been an
psychological impact while dealing with
even bigger movement to show support to the
situation of life and death as front line
HCWs.
warriors. Lot of brain storming sessions with
junior surgical colleagues have helped
This metamorphosis has included generous
surgical department scope up with the crisis
donations of unconditional food supply chain
situation by managing both COVID and non
through the day by many philanthropic
COVID surgical work. Administrative heads
associations , donations for PPE by many
should and have led an example of true
corporates through the corporate social
leadership qualities and this has helped the
responsibility (CSR) funding, donations by
entire medical fraternity unite against the
religious trusts, public personality personalities,
menace of this disease.
National Medical and Surgical association which
has not shared the financial burden on the
When do we start afresh
government but also boosted the morale of every
HCWs by showing a joint solidarity in these This is the most challenging part for the
times of despair. The social media has done a surgical community on how to get back to
good collaborative work by and large but in some elective surgical work. We all have done

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Al Ameen J Med Sci; Volume 13, No.3, 2020 Editorial

watchful waiting over last few months and its Science has progressed in a way never seen
time now to act correctly to get back to before and globally there have been
resumption of work. The Surgical community partnerships between countries to share
stands divided on this prospect and as of now knowledge and develop an effective vaccine
world-wide and we have two categories of which will help prevent the apocalypse which
surgeons , one who wants to go for full may eventually destroy the human race. Social
immersion and the second who want to go as per distancing, hand hygiene, adapting moral
the intensity of the pandemic. The key factor to science and community living will remain the
decide early resumption would be purely based standard of care for years to come, it is
on how fast we get an antibody driven test in the imperative that we follow these guru mantras
market and rapid diagnostics to pick up the viral forever in our life passing it on to the future
antigen. Quality score indices are in place which generations to come. It is time that humans
can be helpful to decide how to prioritise elective decide to strike the ecology balance between
patients. It will be important that a core group in mother nature and animals in our planet as the
every hospital decides criteria based on which current situation we are facing looks like an
patients would be selected for elective surgical undesired outcome of the devastating handling
work [2,5-6]. If proper process is not established of this balance primed with unscientific
earlier on, it would lead to selection bias and lot intentions of the few leading to this pandemic.
of chaos and overcrowding in the hospital, which
in itself will defeat the purpose of social Acknowledgement
distancing. I would like to thank our Dean Dr Hemant
Deshmukh and my colleagues in the department
Future ahead who has been a constant source of inspiration and
support during this tough times. Special thanks to
The rapid development of diagnostic modalities wife Dr. Sejal for her unconditional support,
to isolate patients of COVID has helped us Dr.Banker and Dr. Joanna for their contribution
globally to improve our survival rates, reducing towards this editorial.
the spread of this contagion and identifying the
asymptomatic carriers [8].

Financial Support and sponsorship: Nil Conflicts of interest: There are no conflicts of interest.

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credited and the new creations are licensed under the identical
terms.

*
About the author: Dr. Jignesh Gandhi is a noted expert in General Surgery at Seth GS Medical College &
KEM Hospital, Acharya Dondhe Marg, Parel, Mumbai-400012, Maharashtra, India. He can be accessible by
E-mail: [email protected]

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